How many embryos?

Just wondering if there was a particular point at which people decided to have 2 embroyos transferred instead of 1?

My IVF specialist has said 4 or 5 failed attempts is the point in which she suggests that 2 be transferred. Just wondering what other people's experience has been? Can't decide if the idea of twins is lovely or terrifying (especially if they have significant health problems - am afraid that I would feel responsible and awful forever after for choosing to have 2 transferred if something went wrong).

Hey, i am currently on my 3rd cycle of IVF/ICSI and im still only putting one embryo in, i was told by my nurse and doctor after 3 failed attempts they upgrade to 3 and i think it is also depending on the couples age? From our egg retrieval we got 4 embryo's, we now hav 2 left and my husband and i have decided we would transfer one for the next two goes and then if they both fail we will transfer 2 after our next egg collection. My thoughts are the same on twins, they are very cute but there is the health factor but i think if its ment to be it will and not always does both embryos take so you could still end up with one baby it just gives it a better chance of working having two transfered. I hope this has helped, goodluck xx

We got 3 fertilized embryos out of our stim cycle and FS was very against transfering more than 1. The first transfer failed. Of the 2 embryos we had left 1 was poor quality (only 2 cells when frozen)

Fs agreed to transfer both this time as chances of the second embryo even surviving thaw were poor, and there was no point doing a whole seperate HRT cycle just for that embryo. It survived the thaw alright and by the time of transfer it was over 6 cells. (the other one was so large the embryologist couldn't even make out exactly how many cells were there.

Anyway, we got our BFP with this round. We won't know for a while though if 1 or both made it.
We'll be thrilled either way.

Had we had more embryos though (or if they'd been better quality) the FS would only have allowed 1 per transfer. I think it's a decision that needs to be made in discussion with your FS. Each situation is different.

Hi.
We had 2 embryos available for transfer but we only opted to transfer one as we personally don't want twins. It was only our first full stimulated cycle but they gave us the option to transfer 2. I'm not sure what their reasoning was to have that option, but could be a combination of our ages (36 & 41) and the fact that we had poor looking embryos - heavily fragmented and only 6 cells each on day 3. None made it to freezing.

Originally Posted by Maggie

Of the 2 embryos we had left 1 was poor quality (only 2 cells when frozen)

. I'm surprised to hear how different the clinics can be. Our clinic will only freeze embies that make it to day 5, so was really surprised to hear they freeze with only 2 cell embryos - that would mean freezing on day 1 or 2?

I had my first transfer last Monday so I won't find out if it's worked till Friday, I'm not holding my breath though as my crinone has already turned black and I have no symptoms and my OHSS seems to have disappeared! But we had 2 day 5 embryo's put back and my FS was ok with it, the last 2 times we haven't even made it to transfer.

Mandyjane

Hi,
I am just about to start our 3rd Ivf cycle...I have been only getting 1 good embyro to transfer per cycles and no frozen ones. since the 1st try.I have asked our Dr if she will transfer two next time if i get two good ones.She is still not keen as they dont like the idea of tiwns..But i think after a few no preg results the want to implant more embyros becomes stronger..With our first cycle we had 1 embyro implanted and 1 frozen but the frozen embyro didnt make it through the defrosting process, so i feel it would be beta to have implanted the 2 embyros as it feels like the other little embyro never got a chance to become something special....

I was very cautious and only transferred more than 1 embryo if the second one was going to be discarded and I didn't want it going to waste. I am 40 and the idea of twins terrified me as I know the risks of problems in pregnancy including fetal mortality are raised up to 6 fold with twins over a singleton pg. From my experience IVF is a numbers game and the more number of transfers you do increases your chance of conceiving. From what I have read and spoken about with my FS, transferring more than one embryo doesn't double your chances in a cycle, rather it may increase you chance of a BFP by 5-10% depending on your age and health. However, it also increases your chance of twins by 50-100% if you can get your head around that (ie it is very unlikely that 1 embryo will create twins but much more likely two will create twins). Unlike some FS my FS doesn't recommend multiple embryo transfers even after repetitive negatives and/or if you are older.
For me it is a very personal decision and I always felt uncomfortable for me with the idea of a multiple transfer knowing the risks involved and my desire not to have twins - even after years of infertility I just couldn't cope with the idea of the risk or stress of twins.

Good luck with your decision making.

ETA - there used to be a thread discussing the pros/cons of 1 versus 2 transfer. I will have a look around for you.
ETA2 - sorry had a look around and I can't find it.

Dusty can I ask you a question about your embryo's, you mentioned something about still being able to use an embryo so that it wasn't discarded. Did your clinic offer or did you have to ask them? I also feel really awful about mine being discarded, the scientists at my clinic assure me that my unsuitable embryos stop developing but I'm just not comfortable with it. Last cycle I had a day 3 8-cell (if I remember correctly) embryo that was still 8 cells on day 5 (it didn't form into a Morula or blastocyst) so they wouldn't transfer it. And this cycle just been I had 2 or 3 that were also slow aswell (i think at day 6 one was 11-cells and one was a morula) but because they didn't grow to be blastocyst they told me they couldn't be frozen. I think that they had been at the same stage for a few days as well. Does this sound right to you? I hope so, I wanted to keep them just in case they had any sort of chance.

Zigzag I think my clinic might operate the same way yours does - only freezing day 5 blasts? Maggie you also said you had a 2-cell embryo that they transferred. I'm very confused

MM, I think I only did it twice and both times they were slower embryos (morulas I think) that were still growing but a lot slower than the blasty. We definitely had at least one or two embies discarded each cycle that were slower or which had stopped growing. Its always awful which is why we are now big fans of day 2 freeze as we feel in our situation it gives our embryos more of a chance to be transferred and hence a chance at life.
And yes the clinic gave us a chance at them being transferred although we were supposed to have decided on the number of embryos to transfer prior to the cycle even starting and our choice wasn't revisited until the day of transfer. If your clinic is opposed to transferring a slower or degraded embryo I think you can mount a good case (I've know women to have strongly and successfully advocated for their poorer embie while they have their legs up in stirrups!) to give the embie the chance of life. Just know that while you have some rights over your embies (they rarely mention or acknowledge this), there are also guidelines in Australia for Drs to follow regarding multiple transfer and they may still refuse.

They have a responsibility to take the time to discuss these issues with you, although I know in reality there is sometimes a rush on to get all the transfers done and that the FS needs to rush off for another appointment. If you can, try and discuss all these issues the day or so beforehand with the embryologist and FS to have a game plan and a smooth relaxing transfer.

I think a lot of IF couples get bulldozed into doing what the FS/embryologist wants and are working to their timetables and factory line process of IVF (especially in the big clinics) that is prevalent in Australia now. I finally found a smaller more personal clinic that treats each patient with respect and gives you time and a say in what happens to our embies. I believe this was one of the factors in our eventual success.

Hey my clinic is the same, they only freeze them if they get to day 5, i also hav one frozen at day 6 which is a good thing, as it means if they defrost the day 5 embryo and it dosnt make it apparently they get day 6 embryo out and thaw that one and because it has developed a day longer it dosn't need much thawing time so it means my cycle isnt cancelled.

For our first cycle we had a 2nd day transfer I think. (EPU on Thursday then transfer on Saturday) On the Saturday we were told that we'd probably only get one embryo to freeze because the other one wasn't growing well.
When they called on Sunday though they said that they'd frozen both embryos even though one was only a 2 cell.
That's why we didn't really expect that embryo to do well for our FEt cycle but after the thaw its growth took off and it was perhaps 8 cells by transfer.
Just goes to show- you never do know. I like to think of it as the little runt of the litter who ends up doing well.

Good luck with your cycle Bea06 and anyone else who's about to transfer.
x
Maggie

Maggie, congratulations on getting a positive! I'm always impressed that anyone makes it past the first ivf cycle, it's so horrible. I take my hat off to anyone who can perserve in the face of it AND end up with the desired result! I'd be keen to hear if your pregnancy turns out to be twins.

I agree with you Mandyjane, the repeated disappointment makes it so much more tempting to opt to have 2 put back in.

The scary thing is that i'm absolutely aware of all the stats you noted there dusty and still, I'm so overwhelmed by a desperate desire to have this chapter of my life done and finished with I'm tempted to have 2 put back. It is wearing me down and exhausting me. (Although I can't imagine how worn down and exhausted I might feel with twins)!

The idea of twins also appeals to me on one level as I don't see myself ever going back to do this whole IVF nightmare process again, and I'm greedy and would so love to have more than one!

I can't make up my mind! I suppose I'll see how this cycle goes and no doubt I'll spend the next month worrying about it. It'd be so much simpler to just have sex and get pregnant! I'm sick to death of the whole thing.

Our FS was quite against twins, but nonetheless wanted to t/f two with our more recent FETs. I was keen for one only, but she convinced me and DW to go for two. Ironic as we now have twins on the way, but I can't honestly say I'd change that. That's not to say that twins isn't a big call, expensive and bloody intimidating, especially when you know bugger all about babies like me.

Thanks for your reply Slyder. Can I ask what sort of embroyos you had transferred, were they 2 or 3 day
embroyos or were they blastocysts?

My specialist makes you sign a form if you 2 put back in that says something along the lines of "I understand
that I am doing this against all medical advice". I find it very alarming when it's put like that! And, still, the
thought of having another 50 injections, and internal ultrasounds, medication, of feeling loopy and constantly
coming into work late due to blood tests and the sheer time and energy this whole process takes combined
with the uncertainity of whether it will ever actually work, makes me lean somewhat towards the idea of 2.

What did your specialist say to convince you to put 2 back in if you were feeling reluctant?

That's great that you've made it to 33 weeks, what a relief to be past the danger period for very premie
babies. My other half's cousin had ivf twins which came 3 months early, so the fear of that happening is
lurking about in my head as well.

We always went with blastocysts and were fortunate to be able to achieve good embryo quality and numbers.

We had to sign something similar I think - it's a bum covering exercise because of the medical risks associated with twin pregs. But bear in mind people have been having twins for millenia, so don't get too concerned about that, apart from acknowledging the greater risk of problems.

Realistically, I think if you are going to conceive on a cycle, you'll probably do so regardless of whether you have one or two put back, along the lines of what Dusty said. It probably increases the chance a bit, but won't double it.

When you're starting out I'd be sticking with one for several cycles unless you receive medical advice to the contrary. In our case our FS was more keen to do two as we'd had several goes at one without so much as a bite, and theoretically FETs are supposed to have a little less chance of taking than fresh embryos. In hindsight though I think her advice was a bit silly as we always had nearly 100% cell recovery in the embryos upon thawing, and had had a chemical pregnancy the cycle prior.